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Criminal Division Pilot Program on Voluntary Self-Disclosures for Individuals

Individuals (including through counsel) seeking to be considered for the Criminal Division Pilot Program on Voluntary Self-Disclosures (VSDs) for Individuals may use this form to begin the process of disclosing criminal misconduct. Please note: The Criminal Division Pilot Program and this Intake Form are for individuals who are disclosing misconduct in which they had some involvement.

Identifying Information

Please provide the following information, where applicable. This information will assist in making an initial determination of eligibility. Fields with * are required.

Individuals reporting misconduct through the Criminal Division Pilot Program are not required to be represented by counsel.

Conditions of Eligibility

Having reviewed the qualifying and disqualifying conditions contained in the Criminal Division Pilot Program policy, the reporting individual currently has a reasonable basis to answer yes to each of the following:

  1. The individual is disclosing original information relating to at least one of the programmatic areas of focus listed in the Criminal Division Pilot Program.
  2. The disclosure is voluntary.
  3. The disclosure is truthful and complete.
  4. The individual agrees to fully cooperate and be willing and able to provide substantial assistance in the investigation of related conduct and prosecution of equally or more culpable individuals and entities.
  5. The individual agrees to forfeit or disgorge any profit from the criminal wrongdoing and pay restitution or victim compensation.
  6. The individual:
    1. has not engaged in criminal conduct involving violence, use of force, threats, substantial patient harm, any sex offense involving fraud, force, or coercion, or relating to a minor, or any offense involving terrorism;
    2. is not the Chief Executive Officer (or equivalent) or Chief Financial Officer (or equivalent) of a public or private company or is not the organizer/leader of the scheme;
    3. is not an elected or appointed foreign government official;
    4. is not a domestic government official at any level, including any employee of a law enforcement agency; and
    5. does not have a previous felony conviction or a conviction of any kind for conduct involving fraud or dishonesty.

Privacy Statement

The authority by which information is collected on this website form is 5 U.S.C. 301 and 44 U.S.C. 3101.  Your disclosure of information to the Department of Justice on this form is voluntary. If you do not complete all or some information fields in this form, however, the Department of Justice may not be able to effectively respond.

The principal purpose for collecting this information on this form is to collect, review, and respond to correspondence received by the Department regarding potential criminal conduct to assist the Department in making an initial eligibility determination.  In addition to disclosing this information to the appropriate officials and employees within the Department for the purposes of controlling, tracking, responding to, and maintaining the Department’s correspondence, the routine uses which may be made of the information collected on this form include, but are not limited to: any civil or criminal law enforcement authority or other appropriate agency where a record, either on its face or in conjunction with other information, indicates a violation or potential violation of law; to contractors and others performing or working on an assignment for the Federal government; and under such circumstances and procedures as are mandated by federal statute. 

The full list of routine uses for this correspondence can be found in the System of Records Notice titled, JUSTICE/DOJ-003, “Correspondence Management Systems (CMS) for the Department of Justice,”66 Fed. Reg. 29992 (6-04-2001); 66 Fed. Reg. 34743 (6-29-2001);  67 Fed. Reg. 65598 
(10-25-2002); 82 Fed. Reg. 24147 (5-25-2017).

Updated June 10, 2025